Healthcare Provider Details

I. General information

NPI: 1124832209
Provider Name (Legal Business Name): CONNOR GLEN MURDOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 STOCKTON BLVD
SACRAMENTO CA
95817-1337
US

IV. Provider business mailing address

2130 STOCKTON BLVD BLDG 300
SACRAMENTO CA
95817-1337
US

V. Phone/Fax

Practice location:
  • Phone: 916-520-2460
  • Fax: 916-520-7398
Mailing address:
  • Phone: 916-520-2460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: